Jimmy Devins (Sligo-Leitrim, Fianna Fail)

I wish to share time with Deputies Fiona O'Malley, Keaveney, Cooper-Flynn, Sexton and Moloney.

I am delighted to have the opportunity to speak on this motion. There is no doubt that the work in accident and emergency units has come under intense media scrutiny in the recent past. There are a number of contributing factors for this scrutiny, but chief among them has been the unacceptable levels of delay encountered by patients either waiting for treatment or admission. Some weeks ago, the Minister for Health and Children announced a ten-point plan to deal with these delays. There has been real progress on these proposals to deal with the problems of accident and emergency services. It is worth noting that different problems exist in different accident and emergency units, hence the reason for a multi-factorial approach to dealing with these problems.

One of the proposals deals with the role of acute medical assessment and admission units. There is very good evidence that these units, when properly run and resourced can have a dramatic role in improving the service offered by accident and emergency units. These units provide rapid assessment, diagnosis and treatment of patients referred for urgent medical assessment or admission. Sligo General Hospital, has an excellent proposal for such a unit currently with the HSE. It is imaginative, radical and carefully-costed. I understand the national hospitals office of the HSE is currently evaluating the effectiveness and efficiency of acute medical unit proposals. This is right and proper, but I urge the Minister to ensure that this evaluation is completed as soon as possible. I have no doubt that when the proposals from Sligo General Hospital are evaluated, they will be found to be effective and efficient. When they are implemented, a reduction in waiting times at the accident and emergency unit in Sligo General Hospital will definitely occur.

In the remaining time available to me, I will touch on another element of the motion before us tonight, namely the risk of injury to staff and patients from people who are suffering from alcohol or drug misuse. Staff who work in accident and emergency units work in a demanding environment. They deal with people who may have life-threatening medical conditions. From a patient's perspective, attendance at an accident and emergency unit indicates that he or she is suffering from either an accident or an emergency. Naturally, the patient's anxiety levels are raised. Both of these factors contribute to a highly charged emotional situation. Thus, it is not an overstatement to say that the tension levels in accident and emergency units are very high.

In such an environment, it is very unfair to staff or patients to be obliged to deal with a person who is aggressive because of alcohol or drug misuse. As a junior hospital doctor many years ago, I worked in a very busy accident and emergency unit in the centre of Dublin. I am acutely aware of how difficult an environment an accident and emergency unit is in which to work. The protection of staff and patients is paramount. I strongly support the use of deterrents to prevent or limit aggressive behaviour by drink or drug-fuelled attendees in accident and emergency units.

However, all who have worked or who work in accident and emergency departments agree that careful medical evaluation must be carried out before any action is taken against anyone who is aggressive. The person suffering from an underlying medical problem is not simply treated as if he or she was drunk. It is against the ethos of all who work in the health care industry to summarily dismiss someone who is drunk as simply that, without first carefully checking the person over for other problems. This is not an easy task, but it is done routinely in our accident and emergency units, especially at weekends. If the staff is satisfied that no medical or surgical problem exists, then the natural procedures for dealing with anyone who is drunk or disorderly should come into play, that is, it becomes a matter for the Garda Síochána.

There may well be scope for severe penalties for such disruptive behaviour in a hospital setting because of the vulnerability of other patients. Perhaps the Minister for Justice, Equality and Law Reform should examine that aspect. The motion and the amendment before us tonight are worthy of consideration and I commend the amendment to the House.

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